[Unusual pulmonary involvement in Wegener disease].
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Diagnosis, Differential↗
Biomedical subjects
S Kessler
Publications and source records attributed to S Kessler.
[Dynamic 31-phosphorus magnetic resonance spectroscopy of the m. quadriceps: the effect of sex and age on the spectroscopic parameters].
PURPOSE: 31P-MRS is used to assess the influence of sex und age on quadriceps muscle metabolism before and after exercise. MATERIALS AND METHODS: 32 healthy volunteers (15 women, 17 men, mean age: 38 +/- 17 yrs.) were examined by dynamic phosphorus-31 (31P) magnetic resonance spectroscopy (MRS). In the magnet, the quadriceps muscle was stressed by an isometric und an isotonic form of exercise until exhaustion, respectively. RESULTS: Resting conditions: With increasing subjects' age, the ratio beta-adenosine triphosphate/total phosphate decreased (r = -0.37; p = 0.02). With increasing subjects' age, the ratios inorganic phosphate/phosphocreatine (r = 0.79; p = 5 x 10(-8), phosphomonoester/beta-adenosine triphosphate (r = 0.74; p = 10(-6) and phosphodiester/beta-adenosine triphosphate (r = 0.62; p = 10(-4) increased. The pH was the only one of the evaluated spectroscopic parameters which showed a sex-dependence: Female subjects had a significantly lower pH (7.03 +/- 0.02) than male subjects (7.05 +/- 0.03; p = 0.01). Exercise: With increasing age, the maxima of inorganic phosphate/phosphocreatine were less extreme during both of the exercises (r = -0.42; p = 0.0005). Likewise, the exercise-induced acidosis was less severe with increasing age (r = 0.53; p = 6 x 10(-6). After the end of the exercise, the times of half recovery of inorganic phosphate/phosphocreatine and the pH correlated neither with the subjects' age nor with sex or cross-sectional areas of the quadriceps muscle. CONCLUSION: Sex and age of volunteers affect spectroscopic results. This influence had to be considered in the interpretation of spectroscopic studies.
Adult↗
Antiplatelet therapy: glycoprotein IIb/IIIa receptor antagonists.
The glycoprotein IIb/IIIa antagonists are potent drugs that inhibit platelet aggregation. They are formulated as monoclonal antibodies and synthetic peptides for intravenous use in patients undergoing high-risk angioplasty procedures and in patients with unstable coronary syndromes. Orally active agents are now being evaluated in clinical trials.
Journal Article↗
[Active euthanasia: more transparency or rupture of the dike? (interview by Urs Luthi)].
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Ethics, Nursing↗
Iron release is reduced by mutations of lysines 206 and 296 in recombinant N-terminal half-transferrin.
Human serum transferrin consists of two iron-binding lobes connected by a short peptide linker. While the high homology and structural similarity between the two halves of the molecule would suggest similar characteristics, it has been shown that the pH-dependent rate of release of iron from the N-terminal lobe is quite different from that of its C-terminal counterpart. This suggests that the N-lobe of human serum transferrin has a specific, pH-dependent, molecular mechanism for releasing iron. Sacchettini and co-workers using structural information have hypothesized that two lysines in the N-terminal lobe of ovotransferrin create a dilysine interaction and suggest that this is the trigger for pH-dependent iron release. To investigate this hypothesis, we used a Pichia pastoris expression system to produce large amounts of wild-type nTf, the single point mutants, nTfK206A (Lys 206 to alanine) and nTfK296A (Lys 296 to alanine), and the double mutant, nTfK206/296A. The purified recombinant proteins were then used to measure rates of iron release to pyrophosphate. It was found that the rate of iron release from all three mutant proteins at pH 5.7 (the pH at which nTf would normally release iron) was too slow to measure. Only when the pH was reduced to 5.0 could the rates of iron release from the mutant proteins be reliably determined. Although this precludes a direct comparison to wild-type nTf (the rate of iron release from nTf at pH 5.0 is too fast to measure), it implicates lysines 206 and 296 in the pH-dependent release of iron from nTf.
Alanine↗
Scoring prevalence and severity in gonarthritis: the suitability of the Kellgren & Lawrence scale.
In clinical and epidemiological studies the Kellgren & Lawrence (K&L) scale was mainly used in the past to determine the radiological prevalence and severity of gonarthritis. The dependency of this scoring system on the presence of osteophytes has been criticised, and owing to its varying reliability, its appropriateness in cross-sectional and longitudinal studies is questioned. It was the purpose of this study to test whether the dependency of the K&L scale on the presence of osteophytes is reflected in a higher correlation of the overall score with a separate scoring of 'osteophytes' than with other radiological features. Furthermore we compared the inter- and intrarater reliability with the reliability of individual radiological features. Knee radiographs of 40 patients were graded according to the K&L scale and for the presence and severity of five separate radiological features of osteoarthritis. We found a moderate correlation of the K&L scale with the radiological features of 'osteophytes', 'joint space narrowing' and 'flattening of condyles'. The intra- and inter-rater reliability of the K&L scale was higher than the reliability of the individual radiological features. The K&L scale seems not to be strongly dependent on the presence of osteophytes, i.e. there is not a higher correlation of the overall score with that feature than with other radiological features.
Aged↗
[Bone regeneration stimulated by bone substitute materials].
Prompted by severe problems in autogeneic and allogeneic bone transplantation, intensive efforts were made to find sufficient substitutes. A main demand on these materials, especially in healing of osseous defects, is to achieve results comparable to those of auto- or allografts. These must be related to their biomechanical and particularly to their biological properties, i.e. the ability to form new bone, osseous integration and physiological remodeling. Within different trials in the tibiae of sheep we investigated bone substitutes like hydroxyapatite ceramics (HA) or partially demineralized bone matrix (pDBM) and compared them to the gold standards of autogeneic and allogeneic bone transplantation. Therefore we used two different models: the drill hole model with small size defects of 6 mm in diameter and the shaft defect model as a true-to-life defect with a 5 cm large diaphyseal defect. Evaluation was done by X-rays, histology, microradiography, fluorescent microscopy and morphometry of the small size defects. HA showed only small effects on new bone formation and works merely as an osteoconductor. However, excellent new bone formation was regularly achieved by pDBM in the small defects, whereas it was limited in the large size defects. But considering their mechanism of action, it is possible to bridge large bone defects by pDBM.
Bone Demineralization, Pathologic↗
[Osteomyelitis--imaging methods and their value].
Various imaging modalities are used in diagnosis of acute and chronic infectious endogenous osteomyelitis and exogenous ostitis. The pathophysiological changes of osteomyelitis/ostitis in the bone and surrounding soft tissue are known. Findings in plain film radiography show these changes only in relatively advanced stages of disease. Hence, plain film radiographs are useful as a basic imaging modality by excluding other differentials and as a follow-up modality under therapy. Ultrasound-using advanced technology--offers diagnostic help in acute osteomyelitis, especially in infants. The various techniques of nuclear medicine show much higher sensitivity for detecting osteomyelitis than plain film radiography, but do not permit good separation for bone involvement and infectious changes in the surrounding soft tissue. While computed tomography offers the ability to display bone and soft tissue separately, it has been widely replaced by magnetic resonance imaging using fat-suppressed sequences and paramagnetic contrast media which show the spread of the infectious changes with higher sensitivity and accuracy.
Adolescent↗
[Spondarthritis hyperostotica pustulo-psoriatica: nosologic study with clinical and radiologic presentation in relation to the SAPHO syndrome].
Spondarthritis hyperostotica pustulo-psoriatica (Spond.hyp.pp-Schilling), corresponding nosologically to pustulotic arthroosteitis, is a dermato-skeletal "double system" disease of adults. It consists of the triad (a) palmo-plantar pustulosis (Ppp) or, alternatively, Königsbeck-Barber-type psoriasis, (b) sternocostoclavicular hyperostosis (SCCH), and (c) truncal-skeletal changes with syndesmophite-like, hyperostotic and/or parasyndesmophite-like ossifications of layers of the anterior vertebral ligament taken together in the sense of a desmophytal hyperostosis. There is also a potential for sclerosing inflammatory arthritis of the sacro-iliac joints and "dry" inflammatory arthritis of peripheral joints. Thus, the pustulo-psoriatic terrain seems to have a decisive influence on osseous pathology. A total of 38 cases from a study during the years 1982 to 1992 is analysed with regard to morphological characteristics. Rare cases with diaphyseal and pelvic hyperostotic lesions subsequent to bland sclerosing osteomyelitis constitute an overlapping region to chronic recurrent multifocal osteomyelitis (CRMO) and illustrate the relationship between hyperostotic spondarthritis and CRMO. The syndromes of "acquired hyperostosis" and "SAPHO", the former more radiologically oriented and the latter more clinically oriented, together with mainly CRMO and hyperostotic spondarthritis and its forms, constitute the "Spond.hyp.pp.". Although hyperostosis is a guidepost for the radiologist and SAPHO symptoms are one for the clinician, the syndrome does not represent a diagnosis by itself and requires further differentiation. In this report the entity "Spond.hyp. pp." is considered and required contributions from rheumatologically and osteologically oriented radiologist.
Acquired Hyperostosis Syndrome↗
Are the Duke criteria superior to the Beth Israel criteria for the diagnosis of infective endocarditis in children?
Accurate diagnosis of infective endocarditis may be difficult. The Beth Israel criteria and the newer Duke criteria assign probability to the diagnosis of infective endocarditis on the basis of the presence of common features and manifestations. We reviewed 111 cases of pediatric infective endocarditis diagnosed and treated over 19 years. Each case was classified by the two criteria, and the results were compared. Of 111 cases, 73 (66%) and 18 (16%) were classified as definite by the Duke criteria and the Beth Israel criteria, respectively. No cases were rejected by the Duke criteria, while 21 (19%) of 111 were rejected by the Beth Israel criteria. In 18 pathologically proven cases, reanalysis without pathological data showed that the Duke criteria had significantly greater sensitivity (83%) than the Beth Israel criteria (67%) (P < .03). Echocardiographic evidence was required in 22 cases for definite classification by the Duke criteria; none were rejected, however, when echocardiographic findings were ignored. Our results suggest that the Duke criteria are superior to the Beth Israel criteria for the diagnosis of pediatric infective endocarditis.
Adolescent↗
Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study.
OBJECTIVES: Different prevalences of generalised osteoarthritis (GOA) in patients with knee and hip OA have been reported. The aim of this investigation was to evaluate radiographic and clinical patterns of disease in a hospital based population of patient subgroups with advanced hip and knee OA and to compare the prevalence of GOA in patients with hip or knee OA, taking potential confounding factors into account. METHODS: 420 patients with hip OA and 389 patients with knee OA scheduled for unilateral total joint replacement in four hospitals underwent radiographic analysis of ipsilateral and contralateral hip or knee joint and both hands in addition to a standardised interview and clinical examination. According to the severity of radiographic changes in the contralateral joints (using Kellgren-Lawrence > or = grade 2 as case definition) participants were classified as having either unilateral or bilateral OA. If radiographic changes of two joint groups of the hands (first carpometacarpal joint and proximal/distal interphalangeal joints defined as two separate joint groups) were present, patients were categorised as having GOA. RESULTS: Patients with hip OA were younger (mean age 60.4 years) and less likely to be female (52.4%) than patients with knee OA (66.3 years and 72.5% respectively). Intensity of pain and functional impairment at hospital admission was similar in both groups, while patients with knee OA had a longer symptom duration (median 10 years) compared with patients with hip OA (5 years). In 41.7% of patients with hip OA and 33.4% of patients with knee OA an underlying pathological condition could be observed in the replaced joint, which allowed a classification as secondary OA. Some 82.1% of patients with hip and 87.4% of patients with knee OA had radiographic changes in their contralateral joints (bilateral disease). The prevalence of GOA increased with age and was higher in female patients. GOA was observed more often in patients with knee OA than in patients with hip OA (34.9% versus 19.3%; OR = 2.24; 95% CI: 1.56, 3.21). Adjustment for the different age and sex distribution in both patient groups, however, takes away most of the difference (OR = 1.32; 95% CI: 0.89, 1.96). CONCLUSION: The crude results confirm previous reports as well as the clinical impression of GOA being more prevalent in patients with advanced knee OA than in patients with advanced hip OA. However, these different patterns might be attributed to a large part to a different distribution of age and sex in these hospital based populations.
Age Factors↗
More on the role of the school in ADHD.
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Attention Deficit Disorder with Hyperactivity↗
Psychological aspects of genetic counseling. XI. Nondirectiveness revisited.
Directiveness and nondirectiveness are considered here as psychological phenomena and separated from the issue of giving or withholding advice. The former is a form of persuasive communication involving various combinations of deception, coercion, and threat, whereas the latter describes procedures that promote and enhance the autonomy and self-directedness of clients. Examples are given showing that professionals have considerable difficulty dealing with relatively simple, common issues arising in genetic counseling. It is suggested that many, if not most, problems involving the issue of nondirectiveness arise because of inadequacies in applying basic counseling skills. Several examples are given of nondirective counseling in situations involving direct questions and the proffering of "advice." The need to raise standards in counseling training is underscored if the field of genetic counseling is to remain nondirective.
Genetic Counseling↗
Benign giant cell tumor of bone with osteosarcomatous transformation ("dedifferentiated" primary malignant GCT): report of two cases.
It is not uncommon for sarcomatous transformation of giant cell tumor (GCT) of bone to occur after radiation, but rarely does malignant transformation occur spontaneously, with less than 15 cases reported up to 1995. Only four of these cases have been documented in detail. We report two additional cases of GCT of bone spontaneously transforming or "dedifferentiating" into osteosarcoma without radiation therapy. The first case is absolutely unique and most interesting in that the dedifferentiation process occurred in one of multiple GCT lung metastases 6 years after successful eradication of a primary tibial tumor. The right lung was resected due to development of a large tumor, and at pathologic examination, demonstrated several small nodules of conventional GCT and a much larger, 14-cm mass composed of a mixture of GCT and high-grade osteosarcoma. The second case involved a physician, who had a large tumor in the sacrum with vague symptoms for 8 years. Open biopsy revealed conventional, benign GCT of bone with a secondary aneurysmal bone cyst. Complete curettage 2 weeks later revealed, in addition to areas of conventional, benign GCT a second component of very high grade osteosarcoma. Both patients died less than 1.5 years from diagnosis. This report of osteosarcomatous transformation of a conventional GCT of bone strengthens the theory that there is a mesenchymal cell line in GCT that may spontaneously transform to sarcoma.
Adult↗
Assessing health in musculoskeletal disorders--the appropriateness of a German version of the Sickness Impact Profile.
The Sickness Impact Profile (SIP) is gaining increasing popularity in clinical and epidemiological studies, assessing health status or the impact of therapeutic interventions. The SIP was created as a global measure, assessing generic dimensions of health. As there were only a few such methods available in our country, we decided in 1990 to validate a German version of the SIP and to test its appropriateness in patients with musculoskeletal disorders. Due to the up-to-dateness of our results, we decided to publish now the data of this German version of the SIP. Reliability, validity and sensitivity to change of the German version of the SIP were tested in 299 patients with musculoskeletal disorders. The test-retest correlation was high for the overall score (r = 0.81), as well as for Cronbach's alpha (r = 0.83). Results for categories were significantly lower. Validity was tested by comparing the SIP to the Keitel Index (r = 0.6) and to the Measurement of Patient Outcome Scale (r = 0.72), as well as to a control group, which showed significant differences in all categories and in the overall score. Furthermore, the SIP was able to demonstrate therapy-related improvements in health in all our patients. We concluded that the german version of the SIP fulfilled statistical test criteria. The results were comparable to those achieved in the original American version. A cross-cultural comparison using the SIP is justified for at least those patients with musculoskeletal disorders.
Adult↗
Genetic counseling is directive? Look again.
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Coercion↗
Cartilage viability with interpolated skin flaps: an experimental study.
Although composite cartilage grafts are often used in conjunction with a midline forehead flap to repair full-thickness nasal defects, the timing of pedicle division, which optimizes cartilage viability, has yet to be determined. A rabbit animal model was designed to investigate this question. The skin flap pedicle was divided at 0 days, 4 days, 3 weeks, 6 weeks, and 10 weeks in each of five groups of five animals. Although early pedicle division led to partial skin flap necrosis, the cartilage grafts tolerated this ischemic period better. Cartilage viability was approximately 70% and did not differ significantly between the five groups. It is concluded that a larger composite graft and better definition of the skin flap's critical period are needed to determine optimum timing for pedicle division in this animal model.
Analysis of Variance↗
Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis and other inflammatory diseases, with a contribution on the possibilities of computed tomography.
In patients with long standing rheumatoid arthritis and other rheumatoid disorders, stress fractures and insufficiency fractures are not uncommon. The cause may be osteoporosis due to rheumatoid arthritis, corticosteroid therapy, joint stiffness, and deformity of the joints caused by the inflammatory process. Also, unaccustomed exercise after reconstructive joint surgery may be a cause of fractures in these patients. Fractures can be documented on conventional X-ray-pictures and tomograms. Computed tomography can show the medullary extent of these fractures and gives, in several cases, additional information showing the combination of insufficiency fractures with fragmentations of parts of the involved bone. Reconstructive surgery with total joint replacement may be another cause of the development of these fractures. This unaccustomed increase in ambulation may lead to stress fractures in other joints of the same extremity or of contralateral extremity. Pain beginning in joint of the lower extremity in a patient with chronic rheumatoid arthritis should, besides arthritis, raise the possibility of a stress fracture. Also with cases of angular deformity of a joint and unaccustomed exercise after reconstructive surgery patients stress fractures may be seen and can be established by Plainfilm, Computed Tomography scintimetric bone scanning and MRI.
Aged↗